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Tobacco Addiction-Reply

Donald R. Wesson, MD; Walter Ling, MD
JAMA. 1996;276(16):1299-1300. doi:10.1001/jama.1996.03540160021020.
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In Reply.  —Dr Lyman's concern that we did not mention nicotine as an addictive drug was echoed by several of our colleagues. Nicotine is increasingly being viewed as an addictive drug among addiction medicine specialists; however, smoking cessation treatment is often provided separately from treatment of other chemical dependencies and is generally not provided as part of the treatment of alcohol and other drug disorders. Most people who are dependent on alcohol and other drugs smoke cigarettes. A recently published study1 reported the cumulative mortality from tobaccorelated causes (50.9%) among patients previously treated for alcohol and other drug dependencies exceeded that of alcohol (36.0%). As a practical matter, patients undergoing treatment for alcohol or other drug dependencies are often resistant to stopping smoking while they are undergoing treatment. A common response is, "Yes, I want to stop, but not now." Insurers and managed care organizations generally will not pay extra for

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